U.S. Adopts New Allergy Guidelines
The National Institute of Allergy and Infectious Diseases (NIAID) has released the first-ever comprehensive set of guidelines for allergists, general practitioners and emergency physicians with expert recommendations on how to diagnose, treat and manage food allergies, including anaphylaxis.
In a media conference call on December 3, two experts discussed how the need for these guidelines arose out of evidence that not all children and adults are being diagnosed using the same set of protocols.
The guidelines aim to clear up confusion on several issues, such as what medications to use during an anaphylactic reaction. While antihistamines are still often used as the first line of defence, the experts stress that epinephrine should be the first medication administered.
The guidelines discuss the efficacy of different allergy testing such as the skin prick test, blood test and the gold standard: the oral food challenge.
Dr. Hugh Sampson of Mount Sinai’s School of Medicine, one of two experts on the media call, stressed that he and other allergists are seeing too many children “who are put on very highly restrictive diets” and then, when tested or challenged, these children are often found not to be allergic.
Sampson explains there has been a lot of confusion between sensitization – meaning a person may produce some IgE allergy antibodies to a food – and clinical reactivity, which indicates a person is truly allergic.
The new guidelines show that diagnosis of food allergy is not just about one skin or blood test but also history of symptoms and in some cases an oral challenge may be done. (This involves having the patient eat the food in question, starting with a tiny amount.)
While the tests carry the risk of anaphylaxis for the patient and are time-consuming for both the doctor and the patient, Dr. Sampson and his colleague Dr. Matthew Fenton of NIAID expressed hope that the guidelines would result in more of these definitive tests. The guidelines, of course, explain the circumstances under which a doctor should be recommending an oral challenge.
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Read the news release here.
Read information for patients here.
Podcast with experts and the media here.